Ariel Washington

A Comparison of Neighborhood Socioeconomic Deprivation Measures and the Association with Survival among Black and White Women with Endometrial Cancer

Abstract Background: Black women with endometrial cancer have twice the mortality compared with White. Survival disparities remain after accounting for individual-level socioeconomic and cancer-related factors. We investigated associations between area-based deprivation and survival and explored whether area-based deprivation attenuates the association between race and survival, among a cohort of Black and White women. Methods: Data from endometrial cancers diagnosed between 2013 and 2022 were collected from a comprehensive cancer registry covering Metropolitan Detroit. Addresses at diagnosis were linked to the area deprivation (ADI) and social vulnerability (SVI) indices. Adjusted Fine and Gray models and Cox proportional hazard models were run investigating associations between area-based deprivation measures and survival; analyses were conducted estimating the proportion of the association between race and survival that was attenuated by area-based measures. Results: Higher deprivation was associated with poorer survival, adjusted for race, insurance status, and tumor characteristics. Compared with the least disadvantaged quartile, the quartile with the highest disadvantage using ADI and SVI had 1.18 [95% confidence interval (CI), 0.99–1.43] and 1.40 (1.14–1.71) times the hazard of endometrial cancer–specific mortality, respectively. ADI and SVI attenuated 18% (3%–38%) and 27% (10%–48%) of associations between race and mortality overall and 24% (95% CI, 3%–61%) and 40% (95% CI, 16%–78%) among those with high-grade histology. Conclusions: This study demonstrates a clear association between neighborhood-level disadvantage and survival among women with endometrial cancer living in Metropolitan Detroit. Neighborhood disadvantage attenuates the relationship between race and survival, particularly among those with high-grade histology. Impact: These findings serve as motivation to understand how neighborhood affects cancer outcomes.

A Systematic Review of the Effectiveness of Cervical Cancer Screening and Prevention Interventions for African American Women: Implications for Promoting Health Equity

African American women suffer under the burden of cervical cancer as they are first in mortality, diagnosed at later stages, and have a survivorship rate that is lower than the national average. The aim of our review is to evaluate the effectiveness of cervical cancer screening and prevention interventions for African American women living in the United States and to assess their commitment to health equity. A literature search was conducted using PubMed, Embase, CINAHL, and Scopus using MeSH terms related to cervical cancer, human papillomavirus (HPV), screening and prevention, and African Americans. This resulted in 1970 articles. Studies were included if they promoted cervical screening or prevention, sampled African American women aged 18 and over, and evaluated interventions. Among the 23 articles that met inclusion criteria, there were a wide variety of intervention strategies, that is, community health workers, patient navigation, patient reminders, self-sampling collection, and HPV vaccination. Health education interventions, when coupled with patient navigation or community health workers, were effective in promoting screening participation (odds ratio: 2.43, 95% confidence interval: 1.47-4.02). There were mixed results regarding the incorporation of health equity principles. This review supports the importance of incorporating health equity principles and community based methods in screening and prevention interventions. Future research and practice should incorporate African American women's perspectives in intervention development and implementation.

“We’re Not Taken Seriously”: Describing the Experiences of Perceived Discrimination in Medical Settings for Black Women

Cervical cancer disparities persist for Black women despite targeted efforts. Reasons for this vary; one potential factor affecting screening and prevention is perceived discrimination in medical settings. The purpose of this study was to describe experiences of perceived discrimination in medical settings for Black women and to explore the impact on cervical cancer screening and prevention. This paper presents mixed methods results using the Discrimination in Medical Settings (DMS) scale and qualitative interviews to understand the medical experiences of Black women. We administered the DMS scale to 48 Black women and interviewed five about their experiences engaging in the healthcare system. High levels of perceived discrimination were experienced by our sample, with the majority of women having experienced discrimination in the medical setting. Qualitative data contextualized these results, including the impact on the patient-provider relationship and on the development of medical mistrust. Most women reported they had been screened within the last 3 years (75%) and had seen a doctor within the past year (89.6%). Black women are engaging in healthcare while experiencing perceived discrimination in medical settings. Future interventions should address the poor quality of medical encounters that Black women experience.

A Systematic Review of the Effectiveness of Health Education Programs for Cervical Cancer Prevention in Rural Communities: Implications for Promoting Health Equity

Rural women face an increased risk of cervical cancer diagnosis in comparison to women living in metropolitan areas. This review synthesized and critically evaluated cervical cancer screening interventions that target women living in rural communities in the USA. EBSCO, JSTOR, Medline, PsychINFO, Psychology and Behavioral Sciences Collection, PubMed, and Cochrane Library were searched using keywords related to cervical cancer screening, rural communities, and prevention interventions. Study eligibility included randomized controlled trials or quasi-experimental designs, a psychosocial or educational intervention targeting cervical cancer prevention, and implementation in a rural setting. Eleven articles met criteria for the systematic review and 6 of those included information sufficient for meta-analysis. Cochrane guidelines, CONSORT-Equity 2017, and PROGRESS-Plus were used to assess included studies. The systematic review encompassed 9720 participants who were involved in a variety of intervention types: social media campaigns, faith-based, and patient navigation with lay health advisors. None of the studies met all criteria for the health equity assessment. The meta-analysis found that women in the intervention groups were more likely to participate in cervical cancer screening than women in control groups (OR: 2.43, 95% CI: 1.49 to 3.97). The type of intervention mattered in increasing cervical cancer screening participation for women living in rural communities. Educational interventions in combination with patient navigation saw the most success in promoting cervical cancer screening. Further, health inequities focus is lacking robust consideration. Our results highlight a continued need to develop multicomponent interventions with a health equity focus to address barriers to screening and prevention.